Preoperative Cognitive Optimization and Postoperative Cognitive Outcomes: A Narrative Review

Area of Science:

• Geriatric Medicine
• Neuroscience
• Surgical Patient Care

Background:

• Perioperative neurocognitive disorder (PND) is a significant concern for millions of older adults undergoing surgery annually in the US.
• Effective prevention strategies for PND remain elusive.
• Preoperative cognitive interventions are being explored to mitigate postoperative delirium.

Purpose of the Study:

• To review and interpret existing research on preoperative cognitive optimization in older surgical patients.
• To assess the current evidence supporting cognitive optimization as a PND prevention strategy.
• To identify knowledge gaps concerning older surgical populations and cognitive interventions.

Main Methods:

• A comprehensive literature search was conducted in PubMed (1995-2024).
• Keywords included 'Older Surgical Patients,' 'Cognitive Optimization,' 'Postoperative Delirium,' and 'Prehabilitation.'
• Included studies were full-text articles investigating cognitive function in older adults, encompassing clinical trials, case series, cohort studies, and reviews.

Main Results:

• Evidence for preoperative cognitive optimization's impact on postoperative cognitive function in older adults is currently limited.
• Some studies indicate preoperative cognitive training can reduce postoperative delirium.
• However, other studies show no significant effects, necessitating further investigation into training parameters.

Conclusions:

• The efficacy of preoperative cognitive training for preventing PND requires further investigation, particularly regarding optimal dosage, duration, and delivery methods.
• Research is needed to evaluate these interventions in presurgical patients with pre-existing cognitive impairment or dementia.
• Further studies are crucial to establish effective cognitive optimization strategies for older surgical patients.